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The Posterior Reversible Leukoencephalopathy Syndrome (PRES), secondary to immunosuppressive calcineurin inhibiting drugs, is a frequent neurological complication in post-transplanted patients. Presentation is variable, that said, PRES should always be ruled out and treatment started, out prior to an onset of an acute neurological manifestation. We present the case of a 67-year-old man with pulmonary fibrosis who underwent right lung transplantation, under immunosuppressive treatment with tacrolimus, mofetil micophenolate, and prednisone. During his stay post-transplant, he presented acute neurological symptoms, and systemic arterial hypertension; his tacrolimus levels were taken and resulted within normal range. Then, imaging studies were performed showing alterations in cerebral Magnetic Resonance Imaging (MRI), although discarding thrombotic or cardioembolic vascular events. The dose of tacrolimus was suspended corrected, to which then the patient showed clinical improvement in the days after. A second MRI was taken, showing improvement of previously seen alterations.
